Abdominal tumours in infants and children.

If abdominal tumours in children were symptomatic more often than they are, diagnosis would be simple and indications for management clear. However, abdominal tumours are usually silent. Frequently they are discovered accidentally. They may well be diagnosed by chance in the systematic work-up for apparently unrelated symptoms, as, for example, in a child with a fever of unknown origin who has dullness to percussion at his left base on physical examination and in whom a chest film reveals not pneumonia but a retroperitoneal tumour. When one speaks about abdominal tumours in children two major tumours come to mind, the embryoma of the kidney or Wilms' tumour and the neuroblastoma. These two tumours are thought of almost to the exclusion of others and perhaps rightly so. They are not only the most usual and the most dangerous to life, but are also amenable to treatment, if happily the diagnosis is made early. Long experience with these killers of children leads one to a philosophy of tumour management. In America, at least, cancer is the No. 2 killer of children, exceeded only by accidents. Probably the same is more or less true in Britain although you do not seem to lead the frantic lives that we do and perhaps cancer is even more important as a cause of paediatric death than are accidents. It is our firm belief that abdominal tumours present an urgency, if not an emergency situation in management. Several valid reasons might be cited in support of this belief but, for the sake of a teaching point, the naive explanation that we give is that in every tumour, such as Wilms', there is a day when metastases take place. Before this day extirpation of the primary tumour should result in a complete cure. After this day extirpation of the tumour has no effect on mortality and in all likelihood even the addition of X-ray therapy and chemotherapy to the surgeon's armamentarium probably alters the prognosis but little. Another keystone in the management of abdominal